Saturday, August 15, 2009

2009/08/16Annie Freeda CruezKUALA LUMPUR:An estimated 80,000 Malaysians may have been infected with influenza A (H1N1). According to the World Health Organisation, this is based on the number of confirmed cases reported by the Health Ministry since May.

Health Minister Datuk Seri Liow Tiong Lai, in revealing the startling figure, said to determine the number of cases in the community, the number of confirmed cases are multiplied by 20.

He acknowledged that health services were straining under the weight of an increasing number of infected patients, with hospitals around the country seeing triple the number of patients compared with before the outbreak. Waiting time at some hospitals is up to four hours.

Liow said doctors and healthcare staff were working around the clock to clear queues.

"People have to wait for hours to be treated. It's really congested."

He said the ministry could not reduce waiting time because of the high number of patients down with influenza-like illnesses.

"What we have done is deploy more staff to outpatient departments and clinics to ease the congestion.

"Doctors are trying their best to clear patients as quickly as possible but the number of people turning up every day is high, between 900 and 1,000."

Liow said WHO had estimated that some 0.1 to 0.4 per cent of the population would die as a result of H1N1.

"However, most deaths will be due to complications of underlying diseases in people with chronic cardiovascular, pulmonary, diabetes, renal disease and immunosuppression," he told the New Sunday Times.

He said 20 per cent of the population could be infected within a year.

"The situation is serious. We have reached a stage where the virus cannot be stopped. It is spreading rapidly and many Malaysians are infected. It is now in the hands of people to stop the spread.

"That people are flocking to hospitals and clinics show that Malaysians are now aware of H1N1 and its symptoms. People now seek treatment quickly."

Many private hospitals and clinics are performing rapid tests to determine if patients have H1N1.

"We have provided anti-viral drugs to all private hospitals to treat patients with H1N1, those who are in the high-risk category, or had high fever continuously for two to three days."

The ministry has issued clear guidelines to doctors in the public and private sectors as to whom they should prescribe the anti-viral drug Tamiflu, and who should be admitted and isolated and placed in intensive care units.

"Doctors no longer have to do throat swabs to treat people with Tamiflu. If they have the symptoms and fall into the high-risk category, have underlying symptoms and co-morbid conditions, they can be put on the drug immediately.

"We are also acquiring more Tamiflu to cater for another 10 per cent of the population. We will make sure there are sufficient anti-viral drugs to treat 20 per cent of the population. We are also replenishing the stock of seasonal flu vaccines."

The ministry has also drawn up a contingency plan for the second wave of the pandemic.

It is looking into more manpower, staff, ICU beds and drugs besides ensuring more hospitals have the laboratory facilities to test for H1N1.

Liow said the ministry would put in place all the contingency plans as stipulated in the National Influenza Pandemic Preparedness Plan and be prepared for a worst-case scenario.

August 15 incidence cases of Taiwan, the emergence of a second H1N1 Type A influenza deaths, the deceased was from July 25 on the incidence of 6-year-old girl.

According to Taiwan's "Central News Agency" reports, the command center the evening of the epidemic in Taiwan issued a press release said that the dead girl there on July 25 a high fever, sore throat and other cold symptoms, the same day to the clinic for medical treatment, the situation is not improved, to July 30 Medical Center for treatment, patients diagnosed with pneumonia confirmed by the rapid screening, the woman was admitted to hospital intensive care unit, despite the full treatment of health care workers are still at noon today whose condition had deteriorated to the hospital died, died 15:00.

Disease center said that the girl's death regret, sadness, in order to learn from the experience of death, the command center in the August 11 resolution, the Divisional Commander, should be invited to H1N1 influenza and influenza-related Medical Association, held deaths seminars, so that medical personnel on the evolution of severe influenza and disposal of more understanding, familiar and reduce deaths.

So far, H1N1 Type A influenza infections in Taiwan to identify severe cases of a total of 25 cases, 16 cases have been discharged from hospital, four cases transferred to general wards, intensive care unit three cases, two cases of death.

MAHENDRANAGAR, Aug 15 - Swine flu has emerged as a major threat across the border, but the bordering district of Kanchanpur in Nepal has not woken up to the threat.

A tape recorder is the only means available here to raise awareness on the

fatal disease. Twice a day, the recorder blares out swine flu-related information to hundreds of travellers, who enter and exit daily through the Gaddachauki border point, the main Nepal-India border point in the Far West.

The country has so far come across 20 confirmed swine flu cases. The fact that all cases originated abroad means a strict swine flu control mechanism is a must to tackle the threat along the border and shield the population.

Things are different on the other side of this bordering district. Indian authorities have declared the bordering Indian territory a swine flu-prone zone.

District Public Health Office (DPHO) officials concede serious efforts to take on the public health threat are lacking. "The tape is played twice a day. Once in the morning and once in the evening," according to Shiva Dutt Bhatta of the DPHO.

Bhatta says his office plans to set up a health desk at Gaddachauki to inspect suspects. "We have asked the health department to provide 1000 sets of masks and 500 Tamiflu tablets for the desk. The department has not sent any," says Bhatta. "Without masks and medicines, what's the use of setting up a health desk?"

The Mahakali Zonal Hospital has set up a quarantine ward for swine flu patients and hospital officials plan to quarantine patients based on symptoms.

The CDC says health-care workers should be among the first in line to receive the swine-flu (H1N1) vaccine, which the government hopes will be available by mid-October. But will your doctors, nurses, and other medical providers roll up their sleeves? Only 45 percent of health-care workers get a seasonal flu shot every year, citing the same reasons for opting out that patients do: I'm healthy and don't need it; I'm worried about side effects; I'm afraid of needles. M.D.s and R.N.s are better covered than other staffers, like lab techs and home health aides. But everyone needs to improve. The CDC has been campaigning to raise immunization rates among the white-coat set for years. Already, seasonal flu kills 36,000 Americans annually. When swine flu starts surging, ask your provider: did you get your shot?

New Delhi/Bangalore Aug 15 (IANS) With two more deaths in Bangalore, India's swine flu toll has reached 25, even as 165 people tested positive for the virus Saturday to take the total number of infected people in the country to 1,556, officials said.

Two people died of the influenza A (H1N1) virus in the Karantaka capital Friday, taking the toll in the city to three, the officials said.

Shivanna, 55, died at Wockhardt Hospital in west Bangalore and Manjunath, 28, in Vydehi Medical Institute in eastern part of the city.

Shivanna, a resident of Rajajinagar in west Bangalore, was admitted to Wockhardt Aug 12 after complaining of breathlessness. Manjunath, a weaver in Dommasandra on the outskirts of Bangalore, was admitted in a serious condition Aug 13, a Vydehi institute spokesperson said Saturday.

At least 7,752 people have been tested so far, out of which 1,556 are positive for influenza A (H1N1). 'Of the positive cases, 689 have been discharged,' an official statement said.

In Delhi, health ministry officials said a total of 165 positive cases were reported in India Saturday. 'Of the 165 cases, 97 are from Maharashtra, but none of them have a travel history,' the statement added.

Aug 14, 2009 (CIDRAP News) – Federal officials today during a pandemic H1N1 planning update dialed back the number of novel flu vaccine doses they expect in October from 120 million to 45 million, listing several reasons for the smaller projection.

During a late July meeting of a federal immunization advisory panel, which targeted 159 million people to receive the first doses, authorities projected that 120 million doses would be available in October, with another 80 million per month in the following months.

However, during a National Biodefense Safety Board (NBSB) teleconference today, Dr. Robin Robinson, director of the Biological Advanced Research and Development Authority (BARDA) at the US Department of Health and Human Services (HHS), said the latest expectation is 45 million doses by mid October, with manufacturers delivering 20 million doses per week after that.

He said the revised estimate is based on several factors expected to slow vaccine delivery from manufacturers. Health officials have already acknowledged that yields of the novel H1N1 antigen are less than for the seasonal flu vaccine. Robinson also said vaccine makers have a limited number of fill-and-finish sites, which are just completing seasonal flu vaccine production, but that federal officials are looking for ways to maximize the current capacity.

CSL Biotherapies, an Australian company that is one of the five manufacturers making pandemic H1N1 vaccine for the US market, has a contractual obligation to produce vaccine first for its home country, Robinson said. Because Australia is in the midst of the Southern Hemisphere's flu season, the United States will work with CSL to ensure that it can deliver vaccine doses to both countries.

Another factor that has added to the delay in ramping up production of the novel flu vaccine is that one of the companies making seasonal flu vaccine is having problems finishing up production so that it can clear the decks to make novel flu vaccine, Robinson said. The delay has impacted vaccine timelines by 4 to 6 weeks, he said.

A new seed strain developed to replace the slower-growing strain in lab studies looks like it will produce better novel H1N1 antigen yields that are on par with those for the seasonal vaccine, Robinson said, adding that federal officials will be working with manufacturers over the next 2 weeks to see if the improved yields are also seen in commercial production.

In an update on the nation's antiviral stockpiles, Robin said that 84 million treatment courses are currently in federal and state stockpiles and that 3 million more doses are expected soon. He projected that a total of 100 million antiviral treatment courses will be available this fall, but he added that only a small amount will be available commercially.

Federal officials are currently discussing if the experimental antiviral drug peramivir should be allowed under an emergency use authorization (EUA) for treating critically ill seasonal or novel flu patients. He said a final decision would be made soon. Peramivir, a neuraminidase inhibitor developed by BioCryst Pharmaceuticals, can be given by intravenous (IV) or intramuscular (IM) routes. Phase 2 study results of the drug were disappointing. However, the company announced in mid July that initial phase 3 study of an IV version of the drug conducted in Asia showed that the drug was safe and well tolerated.

During the comment part of the meeting, some of the NBSB board members and members of the public expressed concerns about the current lack of an IV or IM antiviral treatment, urging officials to strongly consider approving an EUA for peramivir.

- The 14 / 8, Nguyen Huy Nga, Director Department of Department of Health and Environment (Ministry of Health) said up to this time, Vietnam had 63 more cases with positive influenza A (H1N1 ). Thus, up to 17h on 14 / 8, Vietnam has recorded 1,363 cases of influenza A/H1N1 positive, with 2 deaths.

In the 63 influenza A/H1N1 infection was detected on 14 / 8, South 40 cases, and the North Highlands area every 10 cases, 2 in the Central case.Number of patients was the hospital in 1024 of which 339 cases are currently being re-isolation, treatment at hospitals, treatment facilities, monitoring community health status is stable.

To cope with the risk of disease spreading to the community, the Ministry of Health has issued guidelines setting the hospital applied to all local outbreaks. Accordingly, the hospital level 1 is set when at least 20 patients with influenza A/H1N1 in schools, factories, enterprises, offices and facilities in the Middle East. But the hospital level 2 will be established when the number of infected adults, influenza virus capable of variation, with risk of death, some cases have serious complication to hospitalization caused overload condition .

Previous events of A/H1N1 flu spread rapidly in the community, Deputy Prime Minister Nguyen Thien Nhan requested the Ministry of Health continue to speed and guide the ministries, agencies Ministries, Governmental agencies and Commission staff the provinces and cities directly under the central government to strengthen further the flu A/H1N1, building report on flu A/H1N1 of local and from the public and to date, sent to the Ministry of Health to general reports of the Prime Minister before 25/8/2009.-snip-

They said that there would be more dangerous than the "birds" and "pigs" ..

Friday, August 14, 2009 - 21:11

Warned Dr Sami Taha, head of the Movement for "veterinarians without borders", the emergence of a new strain of bird flu in Egypt, after the emergence of endemic disease and avian influenza before 3 years, and the emergence of swine flu virus, which infected more than 400 people so far, pointing to the possibility of integration ferrocene to form a new virus may be more serious.

Taha pointed out that the rapid spread of avian influenza viruses, pigs imposed on all officials and private veterinarians to deal with it, such a pandemic, especially since there are more than 20 thousand poultry farms in Egypt, pointing to the need to have all the farm veterinarian.

Questioned the President of the "Veterinary unlimited" in the Government's announcement to get rid of all pigs in Egypt, pointing out that the figures announced by the veterinary services is incorrect, as it destroyed 150 thousand pigs, while the figures stated in the WHO, Egypt with 350 A pig, in addition to the Declaration of the Ministry of Local Development on the presence of 300 heads, wondering, for the difference between the body and the announcement by the Ministry of Development, the World Health Organization.

SEOUL: A South Korean man who returned from a trip overseas has died from H1N1 flu, becoming the country's first reported death from the virus, the health ministry here said Saturday.

"A man in his 50s died from the new flu after returning from Thailand," Deputy Minister Lee Jong-Koo of the ministry told journalists.

The man in the southeastern province of South Gyeongsang toured Thailand from August 1 to 5 with his colleagues, the ministry said.

He began to show symptoms on August 8 and test results on Friday showed he was infected with the virus. He had been under intensive care at a hospital since August 10, it said.

He died on Saturday morning from pneumonia and other complications caused by the A(H1N1) virus, it said.

"The new flu was the direct cause of his death," Lee said.

South Korea has reported more than 2,000 cases of H1N1 flu since it recorded its first case on May 2 involving a middle-aged woman who travelled Mexico.

The World Health Organisation on Tuesday said some 1,462 people had died from H1N1 flu globally, and that infections were starting to decline in the southern hemisphere but were picking up in several Asian countries.

TOKYO, Aug 15 (Reuters) - A man in his 50s from the southern Japanese prefecture of Okinawa has died from the H1N1 influenza virus, becoming the country's first fatality from the disease, the Health Ministry said on Saturday.

The man had apparently not been overseas, a health ministry official said. Other details were not immediately available.

The H1N1 flu outbreak, declared a pandemic in June, has spread around the world and could eventually affect 2 billion people, according to World Health Organisation estimates.

Japan had confirmed some 5,000 cases of the disease as of last month, when it stopped keeping track.

The virus has killed more than 800 people worldwide since emerging in April.

Friday, August 14, 2009

Novel influenza A (H1N1) virus infection continues to cause illness and death among persons worldwide. Immunosuppressed patients with influenza virus infection can shed virus for prolonged periods, increasing the chances for development of drug resistance (1--3). On August 6, 2009, CDC detected evidence of resistance to the antiviral medication oseltamivir in two severely immunosuppressed patients with novel influenza A (H1N1) virus infection in Seattle, Washington. The two patients were treated in two different hospitals, and their cases were not epidemiologically linked. Both were being treated with oseltamivir for novel influenza A (H1N1) virus infection and had prolonged viral shedding. In both patients, the virus was documented as initially susceptible to oseltamivir, and resistance developed subsequently during treatment with the drug. Testing of viral RNA from both patients by pyrosequencing detected a mutation that results in a histidine-to-tyrosine substitution at position 275 (H275Y) in the neuraminidase, known to be associated with oseltamivir resistance (4,5). The results were confirmed by pyrosequencing, sequencing of the neuraminidase gene, and neuraminidase inhibition testing of virus isolates on August 11. One patient's symptoms resolved after treatment with oseltamivir, and the other patient was receiving treatment with zanamivir and ribavirin as of August 13. An investigation of health-care personnel (HCP) contacts and other close contacts revealed no evidence of virus transmission. This report summarizes the case histories and resulting investigations and highlights the importance of 1) close monitoring for antiviral drug resistance among immunosuppressed patients receiving treatment for novel influenza A (H1N1) virus infection and 2) the implications for infection control.

They said that there would be more dangerous than the "birds" and "pigs" ..

11

Friday, August 14, 2009 - 21:11

.

حذر .

Warned Dr Sami Taha, head of the Movement for "veterinarians without borders", the emergence of a new strain of bird flu in Egypt, after the emergence of endemic disease and avian influenza before 3 years, and the emergence of swine flu virus, which infected more than 400 people so far, pointing to the possibility of integration ferrocene to form a new virus may be more serious.

Taha pointed out that the rapid spread of avian influenza viruses, pigs imposed on all officials and private veterinarians to deal with it, such a pandemic, especially since there are more than 20 thousand poultry farmsin Egypt, pointing to theneed to have all the farm veterinarian.

.

Questioned the President of the "Veterinary unlimited" in the Government's announcement to get rid of all pigs in Egypt, pointing out that the figures announced by the veterinary services is incorrect, as it destroyed 150 thousand pigs, while the figures stated in the WHO, Egypt with 350 A pig, in addition to the Declaration of the Ministry of Local Development on the presence of 300 heads, wondering, for the difference between the body and the announcement by the Ministry of Development, the World Health Organization.

KUANTAN, Fri: All Istana Abdul Aziz workers here have been quarantined until Sunday in the wake of the Influenza A(H1N1) infection involving the Tengku Puan Pahang, Tunku Azizah Aminah Maimunah Iskandariah, and her five children.Members of the royal court, as well as palace officials and staff members, were also prohibited from leaving or entering the palace since Saturday, the day the Tengku Puan Pahang was admitted to the Tengku Ampuan Afzan Hospital, here. This was confirmed by Tunku Azizah Aminah Maimunah when contacted at the hospital's royal ward.

"No one is allowed to leave or enter the palace until Aug 16," she said through a text message.

It was not immediately known how many have been quarantine.

Tunku Azizah Aminah Maimunah also said that she and her five children, aged between seven and 14 years old, who were were admitted to the hospital on Friday, were recovering well. - Bernama

Why is A (H1N1) death rate in Malaysia four times the global case fatality rate?

Health Minister Datuk Liow Tiong Lai should explain why Malaysia’s A (H1N1) death rate is four times the global case fatality rate.

Malaysia’s death toll from A (H1N1) flu has topped 56 since the first fatality three weeks ago.

The influenza A (H1N1) mortality rate in Malaysia is close to 2% instead of the 0.1% to 0.4% as estimated by the Health Ministry. It reflects an unusual phenomenon. Without finding out the crux of the problem, assuming that 5 million of people are infected, probably 100,000 of them will die, instead of 5,000 to 28,000 as estimated by the World Health Organization (WHO).

Stockholm, Sweden, August 14: The death toll due to the H1N1 influenza continues to rise, as the lethal virus spreads its wings across the whole world, health officials inform.

The European Center for Disease Prevention and Control (ECDC) told in its report Wednesday that 873 fresh swine flu cases have been reported in the European Union and European Free Trade Association countries.

Swine flu scene world-wideAround the globe, despite the governments taking all kinds of necessary steps to curb the menace, the total number of positive cases worldwide now stands at 35,025. The influenza H1N1 so far has caused 1,462 deaths worldwide since its outbreak in April, the World Health Organization said Tuesday.

The following is the break-up of confirmed cases in individual countries:

France France has recorded around 1,000 swine flu cases so far and one death. The French government fears that the spread of the virus would accelerate once the schools reopen.

Greece In Greece, the total number of pandemic cases reported till Wednesday were 1,424, including 422 additional cases that were confirmed past week only.

Finland Finland on Wednesday confirmed its second case of swine flu in the Defense Forces, according to a statement released by the military.

Latin America In Latin America, where swine flu surfaced in April. More deaths have been reported in the last two weeks. The disease also inflicted high officials in Latin America.

Mexico With 17 more deaths in Mexico over the past two weeks, the death toll here has jumped to 163, Health Minister Jose Angel Cordova informed Thursday. He confirmed that the government is ready to apply its first swine flu vaccine to cope with the disease.

Brazil Brazil remains the third largest country with maximum number of A/H1N1 deaths, after the U.S. and Argentina. It registered three more deaths due to the influenza Thursday, raising the death toll to 277.

Nicaragua Nicaragua on Wednesday confirmed its first H1N1 death of a 30-year-old woman, the Health Ministry said.

Costa Rica The country’s President Oscar Arias has been quarantined at home, and is reported to be in a stable condition after testing positive for the pandemic disease, official sources revealed Wednesday.

Ecuador The country's Policy Minister Ricardo Patino was diagnosed with the lethal flu, the Health Ministry reported Thursday. He is currently being treated with anti-viral medicine at home.

IsraelThe lethal virus has also hit the Middle Eastern countries. Israel registered its eighth victim of the pandemic Wednesday, the Health Ministry said.

Saudi Arabia Saudi Arabi confirmed two deaths due to the flu Thursday, bringing the death toll to 11. In Palestine, only one death has been reported so far.

Africa The situation in the African continent is more delicate, given widespread diseases, such as HIV and tuberculosis, that make people more vulnerable to the virus.

The government of South Africa has launched an intensive information campaign to help people cope with the pandemic and hold its spread, Health Minister Aaron Motsoaledi said Thursday. The country has 1,910 confirmed cases of A/H1N1 flu and three deaths so far.

Malaysia The pace of the pandemic has not eased in Asia, either. Malaysia reported seven more deaths from the flu, bringing the total number to 51 Thursday.

Thailand, Bangkok, Singapore, Vietnam Thailand's Public Health Ministry Tuesday announced 16 more deaths due to the flu, raising the country's death toll to 97. The flu has killed 22 people in Bangkok, 10 in Singapore, and two in Vietnam so far.

India: The swine flu menace has spread its wings to India as well. With 24 deaths so far, the H1N1 influenza is almost 1300 cases strong in the country.

Australia In Australia, Jim Bishop, country's chief medical officer, said Thursday that the number of H1N1 deaths in the country has reached 102 with 449 people being hospitalized and 109 in intensive care.

Tuvalu Even this small island nation of Tuvalu has not escaped the pandemic. Its first six cases of swine flu were confirmed Thursday, Radio Tuvalu reported.

#188 month oldAdm: Sahyadri Munot Hospital adm. earlier in the week. In between, he had also been taken for a check-up to the Sassoon Hospital, which has been handling very serious cases of influenza A (H1N1) infection.Conf: waitingDOD: 8/12/ or late 8/13

* ["Four of the cases had risk factors like diabetes, hypertension, heart problems or obesity...a 24-year-old man without any hisory of illnesses died on Aug 7, of severe pneumonia and septicemia, and was confirmed to be a H1N1 case on Aug 10....a 10-month-old girl who did not have any congenital problems, had fever and cough symptoms on Aug 1 and was brought for treatment on Aug 6 but died the next day..

Pioneer - 4 hours agoTP - 13 / 8, Ministry of Health sent 12 officers and about epidemiology T.U samples to test for the 160 member delegation travel CĐ School Culture Arts and Tourism Saigon is in isolation the guests of the University Staff Association Farmers Vietnam.This is the largest outbreak in Hanoi, can number of infected influenza A/H1N1 also continue to increase when the test results.

Expected, after two days will have results of all 160 samples tested. Department of Health Hanoi has arranged the three time / day, each time two doctors responsible for monitoring the health of members of the delegation.

Every day, area school officials Farmers Association Vietnam also khử khuẩn, cleaning with Chloramine B.

Dr Penn also revealed that WHO has been alerted informally to the discovery of 'a small number of other Tamiflu-resistant viruses'. -- PHOTO: REUTERS

SINGAPORE has reported a case of Tamiflu-resistant H1N1 virus, said a World Health Organisation (WHO) scientist.

Dr Charles Penn, a scientist with the Geneva-based agency, said on Wednesday WHO has received formal notification of seven cases.

He told The Canadian Press that Japan has reported three cases of resistance; and Canada, Denmark, Hong Kong and Singapore have each found one.

Dr Penn also revealed that WHO has been alerted informally to the discovery of 'a small number of other Tamiflu-resistant viruses' but would not say where they were found or how many there were in total.

Tamiflu is one of only two flu drugs to treat H1N1 cases.

Since its emergence earlier this year, the pandemic H1N1 virus has been resistant to two older flu drugs, amantadine and rimantadine.

Dr Penn said the Tamiflu-resistent H1N1 cases 'look like individual isolated cases,' suggesting that there is 'no onward transmission, or implication of them having originated, from a common source."

He added that laboratories around the world are on the lookout for changes in the pandemic viruses that might suggest a similar problem of resistance.

Thursday, August 13, 2009

Up to 17 hours on 13 / 8, Vietnam has recorded 1,300 cases positive for influenza A/H1N1 in 39 provinces and cities, including 2 deaths.

13 / 8, an additional 25 cases positive for influenza A/H1N1, the South recorded 10 songs, 10 of North, Central of 2, 3 of the Environment.

Currently, there are 1001 cases as the hospital, 299 cases are currently being re-isolation, treatment at hospitals, treatment facilities, monitoring community health status is stable.

In Lam Dong province, to the 13 / 8, had 20 cases with test results positive for influenza A/H1N1.

Earlier, on 12 / 8, Education sector local decisions to close a school when the student does 1 flu infection and 14 children in 5 schools on the territory of Da Lat city to monitor the isolation .

The same day, Lam Dong province has summoned Secretary and Chairman of 12 districts and towns and cities in the province to thoroughly consistent spirit, the best measures, directed to strengthen prevention, prevent flu risk spread on a large scale.

Notification by the Center and for disease control Europe (ECDC), to 13 / 8, the world has recorded 219,681 cases positive for influenza A/H1N1 in 168 countries, territories, including 1882 cases of death.

At present, a variable is complicated in some southern hemisphere countries where now is the winter such as Argentina (deaths: 338), Chile (deaths: 97), Brazil (deaths: 192), Australia ( deaths: 100), New Zeland (deaths: 14).

In Southeast Asia, the disease continues to place complex, the number of new cases increased rapidly, many countries have recorded deaths as Philippines, Singapore, Brunei, Malaysia, Laos, Indonesia. /.

CANBERRA has underestimated by almost two-thirds the share of swine flu patients ending up in intensive care in its pandemic modelling, as the virus continues to stretch the nation's health resources.

Fatalities among people testing positive to the flu strain passed 100 yesterday. About 20 per cent of those who have died were considered healthy before succumbing to the disease.

Chief Medical Officer Jim Bishop said the rate of emergency department visits and intensive care unit admissions for the disease had taken health authorities by surprise.

"There's a higher percentage of those who are hospitalised that end up in ICU (intensive care unit). We've modelled it at around 10 per cent and we're closer to the 27 per cent mark," he said.

The incidence of the new H1N1 strain in the community is tracking in line with the 2007 flu season, which was considered the worst in recent years, infecting around four out of every five people who test positive to influenza.

The strain it has imposed on the hospital system, however, is disproportionately high.

The number of people with flu-like illnesses going to the emergency departments had doubled and, in some jurisdictions, quadrupled, Dr Bishop said.

The disease was "particularly concerning" in the way it infected the lungs and caused respiratory distress, he noted.

But more active intervention, through anti-virals and extra-corporeal membrane oxygenation (ECMO) machines, had kept the death toll in check.

"The good news is that a lot of those people in ICUs are recovering well and more quickly than we had anticipated ... the early indication is that that's a successful approach," Dr Bishop said.

The annual death toll from seasonal flu strains normally runs into the thousands, partly because higher infection rates among the elderly.

The median age of death among seasonal flu victims is 83 years, compared to 56 for swine flu fatalities.

Dr Bishop refused to speculate on the likely final death toll from the pandemic, warning the government's modelling, based on seasonal strains, had its limitations because swine flu infection patterns in the northern hemisphere showed the virus survived beyond winter.

"We're not clear yet that the thing has peaked," he said.

Some 449 people across the nation were in hospital with swine flu yesterday, including 109 in intensive care.

The pandemic virus has infected around 29,000 Australians since the first case was detected here three months ago.

PUNE/NEW DELHI: 37-year-old Archana Kolhe died of swine flu in Pune on Thursday at around 3.45 pm, becoming the 13 th victim from the city and 21 st across the nation. ( Watch Video )

Kolhe died at Pune Shri hospital today, TV reports said.

Earlier, a 26-year-old woman died of the viral disease at a hospital in Bangaloreon Thursday, becoming the 20th victim in the country. ( Watch Video )

Rupa, 26, was admitted to St. Philomena hospital with H1N1 symptoms on Sunday.

Earlier, an eleven-month-old boy and a 75-year-old woman died in Pune, taking the toll in Pune, severely hit by the virus, to 12 and across the country to 19. ( Watch Video )

The boy, Rutwik Kamle was admitted first to a private hospital and then shifted to government-run Sassoon Hospital last evening in a serious condition, official sources said. He died early on Thursday morning. ( Watch Video )

Bharti Goyal, who was suffering from the viral infection, died in KEM Hospital here, they said.

With this, the number of flu deaths here has risen to 12 and across the country to 19. Besides the Pune deaths, one person each has succumbed to the virus in Ahmedabad, Vadodara, Nashik, Chennai and Thiruvananthapuram and two in Mumbai.

Ten people last night tested positive for swine flu in Gujarat, taking the total number of those afflicted by the disease countrywide to 1,203.

While Pune remained the worst-hit area by the disease with 61 new cases being reported from the city, Gujarat's 10 new cases took the number of those infected to 27 in the state.

"All test results that were pending have come and according to them, 10 more people, including three women, have tested positive for swine flu," Gujarat principal secretary health Ravi Saxena said.

The figures include five from Ahmedabad, four from Surat and one from Navsari, Saxena said. In Navsari, a 14-year-old boy has been infected by the virus. According to the available data, a total of 125 fresh cases have been reported, taking the total number of those afflicted to 1,203.

In Bangalore, all of the 10 cases had contracted the virus in the country and had no foreign travel history. Goa also reported one indigenous case. All the eight patients in Delhi and three in Hyderabad had acquired the infection in India.

Inadequate animal monitoring policies may have given ancestors of ‘swine flu’ the opportunity to evolve into a pandemic threat

Since the first reported cases in humans earlier in 2009, so-called ‘swine flu’ — more accurately, the swine-origin influenza A virus (S-OIV) — has garnered considerable media attention and public concern, having emerged seemingly from nowhere as the first potential pandemic of the 21 Century.

Recent findings from an international team led by Yi Guan of the University of Hong Kong, China, and Andrew Rambaut of the University of Edinburgh, UK, have now helped to chart how this new threat arose1. The researchers analyzed evolutionary change in viral genes from samples taken in different years and geographic locations.

Their findings support a model in which pigs act as ‘mixing vessels’ for recombination between different strains of virus from swine, humans and birds, and in which this shuffling process was facilitated by the trafficking of infected animals between Europe, Asia and North America.

Interestingly, the evidence suggests that ancestors of the currently active strain of S-OIV have been circulating and exchanging genetic material in pigs for more than a decade. Guan and Rambaut also note considerable gaps in the viral record leading up to S-OIV’s emergence in humans, and conclude that “lack of systematic swine surveillance allowed for the undetected persistence and evolution of this potentially pandemic strain for many years.”

Aug 13, 2009 12:36 pm US/EasternCONCORD, N.H. (AP) ― New Hampshire's public health director said Thursday that swine flu shots will be provided free sometime this fall and high-risk residents will get the vaccinations first.

Dr. Jose Montero said that once clinical trials on the vaccine are completed, states will have a better idea how many doses they will receive.

Montero said the first to be vaccinated will be pregnant women, people caring for children younger than 6 months, health care and emergency workers, people ages 6 months through 24 years, and people ages 25 through 64 with health conditions putting them at greater risk of complications from the flu.

Insurance companies have agreed to absorb administrative costs of delivering the shots for the high-risk groups, Montero said. He said he has not discussed having them absorb the costs for the rest of the population, but federal funding will cover the costs if insurance does not. New Hampshire has received $3.4 million from the federal Centers for Disease Control and Prevention to pay for swine flu clinics and information outreach, he said.

"Nobody will be rejected in New Hampshire because of money," he said.

The CDC says studies indicate that the risk of infection among people age 65 or older is less than for younger groups.

Montero said lower-risk groups will be immunized as the vaccine becomes more plentiful.

Montero said some questions can't be answered until the trials on the vaccine are completed.

Montero said residents could need three flu shots this fall — one for seasonal flu and two to protect against the swine or H1N1 flu.

Seasonal flu shots are recommended for slightly different age groups. The biggest difference is a recommendation for people age 50 or older to be vaccinated, Montero said.

School nurses have been preparing for the possibility of the virus returning stronger this fall. Montero said swine flu has been active all summer.

Montero, Gov. John Lynch and other state officials offered the same prevention advice given last spring: cover the mouth when coughing, wash hands frequently and stay home one day after the symptoms stop.

More cases of Tamiflu resistant swine flu viruses have come to light, the World Health Organization said Wednesday.

China and Singapore have found Tamiflu-resistant pandemic viruses, Charles Penn, a scientist with the Geneva-based agency, said in an interview with The Canadian Press.

He revealed that the WHO has also been alerted informally to the discovery of a small number of other Tamiflu-resistant viruses. He would not say where they were found or how many there were in total.

"It's a small number. It certainly doesn't change the scale of what we're seeing," Penn said.

The WHO has received formal notification of seven cases where people suffering from pandemic flu were found to be infected with viruses resistant to Tamiflu, one of only two flu drugs that work against these H1N1 viruses. Since the time of their emergence earlier this year, the pandemic viruses have been resistant to two older flu drugs, amantadine and rimantadine.

Japan has reported finding three cases of resistance. Canada, Denmark, Hong Kong and Singapore have each found one.

Chinese authorities haven't yet filed a formal report including information about their case but WHO was alerted to the initial laboratory finding through the Global Influenza Surveillance Network, Penn said. The case occurred Hunan province.

Formal notification involves reporting on details of the case, including whether the patient was taking Tamiflu for treatment of flu or prophylaxis (prevention).

The WHO also wants to know whether the virus has been checked to see if all the genes are those of the pandemic virus or whether the pandemic virus might have swapped genes with the seasonal H1N1 virus.

That would be an unwelcome turn of events: virtually all the human H1N1 viruses circulating over the past year or so have been resistant to Tamiflu. It's an attribute public health authorities would not like to see the pandemic virus acquire.

Penn said to date there is no evidence of that kind of gene swapping - called reassortment. Nor is there any sign that the resistant pandemic H1 viruses are spreading from person to person, he said.

"Basically what it looks like is they are all individual isolated cases. No onward transmission and no suggestion or implication of them having originated, if you like, from a common source," he said.

It has always been expected that some degree of resistance to the drug would arise. Studies done years ago by the drug's maker, Roche, found that in rare cases people taking the drug either for treatment or prevention develop resistance.

"It's been there all the time as an event which can happen with a low frequency. And therefore what we're seeing now is no more or less than we would have expected from those early data," Penn said.

It was long thought Tamiflu-resistant flu viruses would not spread and so didn't pose much of a threat. But in the winter of 2008, the explosive development of resistance in seasonal H1N1 viruses showed the conventional wisdom was unfounded.

Laboratories around the world are on the lookout for changes in the pandemic viruses that might suggest a similar problem of resistance is emerging in them. But so far, no evidence has been found, Penn said.

The Institute for Infectious Diseases collaborated with the University of Oxford. Out of 108 people studied, 50% were still confirmed positive after 5 days of treatment.

TS. Nguyen Van Kinh, Director of the Institute for infectious diseases and Tropical Country for around treating patients infected with influenza A (H1N1) as it exposed a new treatment currently is still two issues concerns. Second, in the treatment exposed by the new control, the Institute collaborated with the University of Oxford - England conducted the investigation, mostly on samples of 108 patients. After five days of treatment with Tamiflu in outbreaks still have most to 49.5% of influenza virus. After 10 days 15.6% and 15 day all clean and viruses in most patients.

Meanwhile, it exposed the treatment if the fever for three days out of the hospital is the patient will be a source of spreading viruses. Therefore the lens make the requirements, should continue to isolation of patients at home in a week to avoid spread viruses. http://pandemicinformationnews.blogspot.com/2009/08/vietnam-still-exposed-to-disturbed.html

This was reported in this article:

On the control-minded, Nguyen Van Kinh, said: After 5 days of treatment nearly 50% of it is still positive for influenza A H1N1, so if 3 days after the fever patients for the hospital, the ability still spreading. So by him, after the patient has been the hospital still must isolation at home for about 1 week and take medication as specified by your doctor.http://pandemicinformationnews.blogspot.com/2009/08/vietnam-50-still-test-positive-after-5.html

And numerous articles this morning, have references to the new information, that is....after 5 days of treatment, 50% are still testing positive.

Need self-isolation after treatmentResults of treatment of influenza A/H1N1, according to research by the Institute after 5 days using Tamiflu, about 49.5% patients and the virus in most. After 10 days, the rate is 15.6%, after 12 days it is 1.8%, exceeding 15 days, the flu virus does not exist.

So, Dr. Glass petitions, when discharge home, patients should self-awareness isolation for 1 week followed by a whole new virus is, if ko is heal people die to get the community.http://pandemicinformationnews.blogspot.com/2009/08/vietnam-ah1n1-flu-are-spread-rapidly-in.html

At the meeting, Mr. Nguyen Van Kinh, Director of the Institute of infectious diseases and tropical countries, also suggested the Ministry of Health consider importing Tamiflu as xi Ro to treat children. Mr. Glass also suggested the Ministry of Health review exposed control of influenza A/H1N1 new regulations. The regulations have to discharge patients after 5 days of treatment if the test 2 times but not with positive influenza A/H1N1. However, according to Mr. Glass, need more isolation at the hospital just to spread the disease to avoid others. http://pandemicinformationnews.blogspot.com/2009/08/vietnam-total-cases-1275.html

and this:

In addition, the exposed control of the new Ministry of Health, Tamiflu is used to treat for 5 days. However, when patients stop taking medications, back home still need isolation in 7 days to prevent the ability to re-spread the community.http://tinyurl.com/r8ruyx

(Dân trí) - "Monitoring influenza at 15 points across the country found that: the number of patients increased influenza A/H1N1, chùm appear in many diseases of local rate-positive patients accounted for 30% of samples tested , many patients infected with influenza A/H1N1 indeterminable source of infection ... ".It is evaluated by Dr. Nguyen Tran Hien, Director of Institute of hygiene and from meetings in the Steering Committee and national flu in place this afternoon (12 / 8).

Many diseases of unknown infectionAt number A/H1N1 flu patients increases daily. Presently, there are 32 provinces with influenza A/H1N1 patients. In the 4 provinces of the disease is chùm Ho Chi Minh, Hanoi, Dong Nai, Khanh Hoa. Only from 4-10/8, at 15 monitoring points Program influenza surveillance in many countries provinces nationwide, the rate of positive influenza A increases. Have the monitoring up to 30% sample test confirmed influenza A/H1N1, concentrated mostly in Vietnam, Hanoi, Quang Tri, Thua Thien Hue. In Hanoi, in recent days, the number of patients examined at the Institute for infectious diseases and tropical countries increased 5-7 times compared to before. Average daily detection of positive 8-10.

According to Nguyen Huy Nga, Director Department of Department of Health and Environment, if patients continue to increase the treatment system does not respond in time, the object in the group as the risk of cardiovascular disease, chronic disease, diabetes, obesity ... there will be risk of death higher.

But Dr. Nguyen Van Kinh, Director of the Institute of infectious diseases and tropical countries that A/H1N1 flu are spread over the community. Manifestation is the appearance of cases do not have a contact with the patient, but living in areas with a patient, but for positive results. As a number of cases infected with H1N1 virus in My Dinh, Vinh Tuy, they could not contact with the object carrying any disease, but found the flu does, hear press propaganda bech much about this disease, the hospital had been examined.

"Even as two of the patients died due to influenza A/H1N1 are unable to identify the epidemiological factors, sources of infection. Latest is TTB patients in Ho Chi Minh City, can not determine the source of disease spread by patients or loiter in the streets, "Dr. Glass said.

Dr. Nguyen Tran Hien, Director of Institute of hygiene and epidemiology TU give proof of the spread of outbreaks of H1N1 disease is chùm Vietnam delegation of 185 participants in a journey through Vietnam. Departing from Ho Chi Minh City today 27 / 7 and 8 / 8, the delegation had the first patient infected with the flu does. This shows that the ability of the large disease infected from the community on the way to the trip.

Or as the disease is detected in the military. 2 positive influenza A/H1N1 in a total of 55 suspects in high-level technical information (Son Tay) was detected after the exchange program We are soldiers held for 3 days from 26-28 / 7 Horses in Pants field, with many units scattered over the provinces of Hanoi, Hai Phong, Quang Ninh participation.

Before the disease spread to the community, he said that Russia must adjust monitoring activities, in accordance with events and in each locality, and also to strengthen monitoring of chùm of disease in the community. People need to raise awareness further, limit the maximum exposure crowded place, wear to the page, wash your hands often.

Should implement screening testIt is suggested by Nguyen Van Kinh, Director of the Institute of Infectious Diseases and Tropical national, state number of previous disease subject samples increased, while the products of the PCR tests are limited.

Hygiene products tested, the difficulties in clearance was about the epidemiology of the additional strengthening of equipment sufficient to make 2,000 sample products disease. However the lens, with the suspect, should first test screening, if confirmed positive influenza A/H1N1 as the new PCR test. This has reduced the waste, has reduced the load PCR samples tested today.

In addition, Dr. Glass also concerns about the treatment for many patients infected with influenza A/H1N1, Dr. Nguyen Van Glass reflects: "The treatment for young children is difficult drug Tamiflu by the membership, 75mg, with children need less, difficult bẻ into 3-4 parts. Therefore, the additional drug Tamiflu siro format for easy use for children. "

Need self-isolation after treatmentResults of treatment of influenza A/H1N1, according to research by the Institute after 5 days using Tamiflu, about 49.5% patients and the virus in most. After 10 days, the rate is 15.6%, after 12 days it is 1.8%, exceeding 15 days, the flu virus does not exist.

So, Dr. Glass petitions, when discharge home, patients should self-awareness isolation for 1 week followed by a whole new virus is, if ko is heal people die to get the community.

Dr. Trinh Quan Huan, Deputy Minister of Health, also said that the isolation For those patients already in hospital is necessary. He emphasized that, in the present, the detection, isolation and early treatment will continue to develop remarkably effective in treatment and reduce mortality. Therefore, the primary treatment still need to coordinate with the military, enhanced training for the treatment of treatment of influenza A/H1N1. Because, coming winter, the weather favorable for development of virus, A/H1N1 flu risk Bùng and strong, can turn into power they have in high. And the number of cases increased, the system is not treated in time to meet the objectives, the risk high easy death.

(VnMedia) - TS. Nguyen Van Kinh, Director of the Institute for infectious diseases and Tropical Country for around treating patients infected with influenza A (H1N1) as it exposed a new treatment currently is still two issues concerns.

Firstly, the treatment for children infected with influenza A (H1N1) is a problem encountered many difficulties, not the drug for any changes Tamiflu membership. Đồ According minded treatment of the current Ministry of Health regulations to the children must be the translation, or oral doses of the inhaled form, but now, Vietnam enter new pill Tamiflu 75 mg, the physician must bẻ each Vienna into 3-4 parts, drugs do not dissolve completely Domestic difficult for children to drink and hard to preserve. Therefore lenses to allow the Ministry of imported form Tamiflu syrup for children drink.

Second, in the treatment exposed by the new control, the Institute collaborated with the University of Oxford - England conducted the investigation, mostly on samples of 108 patients. After five days of treatment with Tamiflu in outbreaks still have most to 49.5% of influenza virus. After 10 days 15.6% and 15 day all clean and viruses in most patients.

Meanwhile, it exposed the treatment if the fever for three days out of the hospital is the patient will be a source of spreading viruses. Therefore the lens make the requirements, should continue to isolation of patients at home in a week to avoid spread viruses.

Related to drug Tamiflu, Department of Pharmacy Management (Ministry of Health) said the inspector checked and have no medication to a buffer in Vietnam and people do not fear a lack of medicine. The Department will require health departments to check the medication and withdraw the license business immediately with the sale of medicine rated. The company entered on this medication with 448,700 VND / box 10 members.

Up to this time, the country has recorded 1,275 cases of influenza A/H1N1 infection, 2 deaths. At 32 provinces, the city had influenza A/H1N1 infection, including 4 local phenomenon has spread to the community of Ha Noi, Dong Nai, Khanh Hoa, Vietnam.

At the meeting, Mr. Nguyen Van Kinh, Director of the Institute of infectious diseases and tropical countries, also suggested the Ministry of Health consider importing Tamiflu as xi Ro to treat children. Mr. Glass also suggested the Ministry of Health review exposed control of influenza A/H1N1 new regulations. The regulations have to discharge patients after 5 days of treatment if the test 2 times but not with positive influenza A/H1N1. However, according to Mr. Glass, need more isolation at the hospital just to spread the disease to avoid others. On 12-8, relating to the drug Tamiflu (influenza A/H1N1 treatment) are sold with a ridiculous price in a number of drugs in HCM City (nld report has information), the delegation Inspection Ministry of Health by Mr Bui Duc The Deputy Chief Inspectorate of Health, the leader, has suddenly check operations of 3 Chau Pharmacy U.S. 1, U.S. 10 and Chau Thanh Quang (Hai Ba Trung Street, District 3). At the time of inspection, the delegation inspected the record this medication is no longer selling drug Tamiflu. Mr. Bui Duc Phong, said the inspection to ensure use of medication safety and effectiveness for people as well as avoid increasing the price of medicine style "té by rain water and create wild psychological bring people .. .

13/08/2009A/H1N1 flu spread to the military and policeAccording to the Steering Committee countries to prevent pandemic flu, the current number of infected influenza A/H1N1 in Vietnam has approximately 1,300 cases with 2 deaths. Recently, Department of Military Health, Ministry of Defense said a number of soldiers and students of the 3 units at Son Tay, Dong Nai and Hanoi infected with influenza A/H1N1.

However, under the Department of Health, Ministry of Public Security, up to this time had 12 officers, soldiers and police units in 6-infected influenza A/H1N1.

To cope with the situation and continue to spread, the Ministry of Health has issued guidelines setting hospital for prevention of pandemic influenza to the local in the country. Dr. Ly Ngoc Kinh, Director Department of Management Department of treatment, the Ministry of Health for setting up the hospital to limit the spread of flu in the community and implementing the collection, isolation, treatment in place avoid overload for hospitals in the province.

Accordingly, depending on the specific disease, there are 2 types of hospital is the hospital level is set if flu occurs in schools, factories, enterprises, offices and basis of the Middle East, the health sector in coordination with the implementation of that.The hospital level II is when people have big, influenza virus capable of variation, with risk of death, some cases have serious complication to hospitalization caused overload situation. Establishing the hospital level II requires the participation of the sector concerned, including the military and the medical role leading.

Related to drug treatment Tamiflu influenza A/H1N1, Dr. Truong Quoc Cuong, Director Department of Management Department of Pharmacy, said Vietnam, in addition pharmacopoeia currently, over 9 million members, the pharmaceutical company also has Vimedimex enter additional 20,000 doses of Tamiflu to people completely assured Vietnam does not lack drug Tamiflu in the treatment.

The report of the Center and for disease control in Europe, up to this morning, 13-8, in the whole world has recorded 215,090 cases positive for influenza A/H1N1 in 168 countries and territories, including 1735 cases of death. In Southeast Asia, the disease continues to place complex, the number of new cases increased rapidly, many countries have recorded patients infected with influenza A/H1N1 death.

A/H1N1 flu spread more and fasterNguyen Van Kinh, Director of the Institute for infectious diseases and tropical countries, said in the meeting notice of events of influenza A/H1N1 outbreaks in Hanoi yesterday afternoon, 12 / 8 of the Steering Committee and National against influenza. Mr. Glass adds, among the positive to influenza A/H1N1, a lot of patients are now not identify the origin spread the disease, due to infected people in communities large and difficult to control.

Currently in Vietnam has been infected many chùm new. Typically 185 teachers, students CĐ School Culture Arts and Tourism Saigon are currently in isolation trip through Vietnam and flu symptoms in Lao Cai to 8.8 nights. Of which 7 had positive with influenza A/H1N1.

On the control-minded, Nguyen Van Kinh, said: After 5 days of treatment nearly 50% of it is still positive for influenza A H1N1, so if 3 days after the fever patients for the hospital, the ability still spreading. So by him, after the patient has been the hospital still must isolation at home for about 1 week and take medication as specified by your doctor.

Wednesday, August 12, 2009

Alexandria - The Egyptian Council of Ministers, headed by Dr. Ahmed Nazif, Prime Minister, decided to stop any new bookings for travel to the minor as of Wednesday, as part of the pursuit of reducing the risks for society and the protection of citizens, comes within the five resolutions of the Council of Ministers during the emergency meeting in Alexandria to follow up the implications of bird flu pigs and its relationship to pilgrimage season this year with Prime Minister Dr. Ahmed Nazif and the Ministers of Defense and the Interior and Religious Endowments and civil aviation, foreign affairs, health and tourism.

The meeting also decided to follow-up continued from the Ministry of Health for the development of epidemiology of swine flu and the possibility of a regional action again upward, if necessary.

The decision came on the second and blessings of Allaah be up travel restrictions to the performance of ritual to raise the minimum age for passengers to 25 years rather than 12 years until the age of 65 years and this restriction applies to those who are already booking for the minor as of Wednesday, according to the recommendations of the regional ministerial meeting of the World Health Organization, which was held in Cairo in the twenty-second of the month of July.

The meeting also decided to raise the degree of surveillance at airports and ports and to continue to precautionary measures and the policy of containment of the Ministry of Health also decided to maintain the Committee of Ministers at the meeting to follow up a permanent position in anticipation of taking any further decisions are required during the immediate period ahead.

For his part, Dr. Magdy Radi, the official spokesman of the Council of Ministers: "The emergency ministerial meeting convened by Dr. Ahmed Nazif Alexandria today comes out of the concern of the Ministry of Health of the danger of integration with the swine flu virus bird flu virus since the bird flu has become endemic in birds Egyptian and this merger produces a new kind of viruses are more dangerous to the citizens of Egypt. "

Radi said that raising the minimum age for traveling to perform Umrah to 25 years rather than 12 years until the age of 65 years comes from the fact that young people under the age of 25 years are most vulnerable to the disease, according to the World Health Organization, where the rate of infection in the world, that segment 70% The youth of this age are more mixed, after their return in clusters of schools and universities.

He said the ministerial meeting decided in this regard, the continued implementation of other restrictions that have been taken during the meeting of the World Health Organization, which includes the necessity for the passengers to perform Umrah health certificate and be free of chronic diseases, obesity and kidney failure, liver and respiratory system, heart, and the vulnerability of pregnant women to take effect This restriction on those who are already booking to perform Umrah as of Wednesday.

For his part, Dr. Hatem el-Gabali and Minister of Health accompanied by the presence of minor pilgrimage season because of the large number of pilgrims, especially from the Egyptian countryside and endemic bird flu, where the Ministry of Health noted the recent increase in the number of cases of swine flu coming from Saudi Arabia, where Saudi Arabia has become during the past few days at the top of the list of countries that have been cases of the disease, which accounted for 23% of the total cases of swine flu, followed by 17% of England and America by 10%.

He pointed out that the number of confirmed cases coming from Saudi Arabia to Egypt amounted to a total of 80 cases of 402 confirmed cases of bird infected pigs in Egypt so far.

AS THE swine flupandemic continues to sweep the world, what do public health officials, epidemiologists and flu researchers think will happen in the coming months?

When New Scientist asked 60 of them, it turned out that half are concerned enough about the possibility of a virulent swine flu outbreak to take precautions such as acquiring a supply of Tamiflu for their families.

Though most do not think it likely that a nastier strain will emerge, many are worried that if it did, their local hospitals and other parts of the health infrastructure could not cope.

Since the emergence of H1N1 swine flu in Mexico and the US five months ago, the virus has affected 168 countries in all continents. More than 160,000 infections have been confirmed and the true figure could well be 10 times that if cases have gone undetected. "This flu spreads very well," says Angela McLean, co-director of the Institute for Emerging Infections at the University of Oxford. While over 1000 people are known to have died, this is a fairly low fatality rate, she says.

No one can say for sure what will happen in the coming months. In the 1918 pandemic, the virus mutated and became more pathogenic over time. Last week, when swine flu fatalities doubled in Argentina - now in its winter flu season - the fear was that the virus had changed, though genetic sequencing proved that wasn't the case.

Although it is not yet possible to predict how the virus might evolve, researchers have hunches like everyone else. So New Scientist decided to email a list of carefully selected individuals from around the world. We asked three simple questions: how concerned were they about an increase in viral virulence, did they think their country's infrastructure could cope if this happened, and were they taking extra personal precautions for themselves and their families.

The exercise was not intended to be scientific. The aim was simply to get a snapshot of opinion at this stage of the pandemic. Do their personal views matter? Probably. After all, these are the people who work day-to-day either studying flu or planning how to deal with it, and they influence regional, national and international strategies for managing the pandemic.

John Oxford, professor of virology at the Institute of Cell and Molecular Biology in London thinks the timing of the straw poll is right. "It's done just at the right moment," he says. "We have reached a balance point between the summer wave and a possible autumn wave. This is an excellent time to stand back a little and reassess and reflect upon the flu situation."

How likely is it that a more virulent strain will emerge? The majority of respondents did not rule it out: two thirds said they thought that higher virulence was "possible". Only a small proportion said it was "likely" (see table).

One respondent, Laurence Tiley, a molecular virologist at the University of Cambridge, says there is no reason to expect that the virus will become substantially more virulent. There have been too few pandemics to make any concrete predictions, he explains.

Around 30 per cent of respondents believe there is a fifty-fifty chance or greater of increased virulence. Oxford adds a caveat to this group's choice. "There is a tendency for people to hark back to 1918 when there was an increase in virulence, but it's different now. In 1918 it was like a missile into a virgin community, where everyone was susceptible," he says. Many people's immune systems have encountered a similar seasonal flu virus, which might lend them some protection against H1N1-type viruses, he adds. "I don't envisage at all a 1918-type scenario, and I'm glad that your experts here agreed."

The 1918 flu pandemic was like a missile into a virgin community

However, Walter Fiers, a molecular biologist at the University of Ghent in Belgium warns that there is still no way of knowing whether the 2009 H1N1 flu virus will mutate, making vaccines under development useless. So he and many of his colleagues are pressing for systematic surveillance of the virus to pick up any changes in behaviour.

A big worry is the possible appearance of a hybrid virus, one that combines the high transmissibility of H1N1 swine flu with the virulence of H5N1 bird flu, where 30 per cent of those infected die. "The nightmare scenario is that someone who is already infected with H5N1 gets swine flu," which would give the two viruses the opportunity to recombine, says John Edmunds, an epidemiologist at the London School of Hygiene and Tropical Medicine, UK.

The nightmare scenario is that someone infected with bird flu gets swine flu

Doubts also emerged over the ability of health infrastructures to cope, should the pandemic mirror that of 1918. Over half of those polled answered that they are "very" or "extremely concerned" that their local health services would be unable to deal with such a virulent wave of swine flu.

So are the respondents worried enough about a severe swine flu outbreak to take their own special measures? They are divided. Half say they have taken no measures. Reasons were mixed: some believe a serious flu outbreak unlikely, others don't feel they are at risk of serious disease, and many stated that they can easily access drugs via their local health infrastructure if necessary. Robert Dingwall, director of the Institute for Science and Society at the University of Nottingham, UK, says, "I am not planning to stockpile. I have every confidence in the availability of [UK] stocks of antivirals and in their continued availability."

The other half of those questioned are taking at least one precaution in anticipation of a severe swine flu outbreak. These include acquiring antivirals such as Tamiflu, or antibiotics for them and their families. Some have had the pneumococcal vaccine to protect against pneumonia, which can occur as a secondary infection. A few have even stockpiled food and water in their homes in case civic services, such as transport networks and food supplies, break down (see table).

Some of them seemed motivated by concern that stocks of antivirals or antibiotics were either absent or likely to run out. One health official in Africa said people in her country are "totally relying on the grace of God" to protect them from the pandemic. Although the respondents were evenly split between lower and high-income countries, around two-thirds of those who had taken special measures were from high-income countries, such as the US, western Europe, Japan and Australia, where government plans are relatively well formed and shortages of medicines are unlikely.

Oxford says that stocking antivirals is not necessary for most people, but he is surprised that more respondents have not chosen to do so because they have easier access to medicines via their work. He adds that such personal preparations can sometimes be prudent, for example, if a person was travelling to the southern hemisphere where swine flu cases are rising fast in the winter season.

These actions may prove to be unpalatable for policy-makers in well-prepared countries because they can fuel public anxieties. Dingwall warns that stocking antivirals may be rational for an individual, but if everybody followed suit the result would be "the very shortages that we might fear".

When New Scientist asked Marie-Paule Kieny, director of the World Health Organization Initiative for Vaccine Research, to comment on the results, she felt the snapshot represented a balanced view of the pandemic. "The experts seem to understand well the challenges ahead: they recognise the risks, but also the uncertainty of these risks," she says.

In the coming months, health authorities should not be complacent just "because they know that the vaccine is coming in a few months and because they have large stocks of Tamiflu in their freezers," says Walter Fiers of the University of Ghent. After all, if the virus mutates significantly before a substantial percentage of the population are vaccinated it will be useless. What's more, Tamiflu resistance can emerge if the drug is widely used on those with very mild symptoms. "The situation needs to be carefully monitored," says Fiers. "Influenza has surprised us many times before."

TORONTO — Unproven assumptions about the course of the 1918 Spanish flu pandemic may be leading to misperceptions of what the swine flu virus has in store for the world, the scientist who decoded the genetic blueprint of the 1918 virus suggests in a newly published commentary.

Virologist Dr. Jeffery Taubenberger, along with co-author and medical historian Dr. David Morens, argues there is no firm evidence that the 1918 virus ratchetted up in virulence in a fall wave - because there is no solid proof outbreaks of illness in the U.S. in the spring of 1918 were caused by the same virus.

Their commentary, published in this week's issue of the Journal of the American Medical Association, suggested changes in virulence or transmissibility of the current pandemic virus are not inevitable. In fact, they wrote, there are reasons to hope for "a more indolent pandemic course and fewer deaths" than seen in many previous pandemics.

"I think every pandemic is completely different," Taubenberger said in an interview from Bethesda, Md., where he and Morens work at the U.S. National Institute of Allergy and Infectious Diseases.

"It emerges in a different way. Its genetics are going to be different. The population immunity by age is going to be different depending on what it is. So I think it's very difficult and perhaps a disservice to assume that a new pandemic is going to behave in a way like 1918."

The scientific community is split about what happened in the opening days of the notorious Spanish flu pandemic, which is believed to have killed upwards of 50 million people in 1918-1919.

The prevailing view is that spring outbreaks of largely mild disease in the United States and then in Northern Europe was actually the opening round - the so-called herald wave - of the pandemic. The received wisdom is that over the summer the virus mutated, making the disease it caused more severe.

The concept that an initially mild pandemic virus could change into something nastier has featured prominently in the logic of public health officials as they have explained why the world needs to respond aggressively to the new H1N1 virus.

But Taubenberger and some others have repeatedly noted that there are no virus samples from the spring wave, so there is no way to confirm that outbreaks were caused by the same virus or that the virus changed to become more virulent.

"So that is an hypothesis. But it is one of several. And we don't know that that's really true," he said.

Taubenberger and a team of collaborators excavated enough particles of the 1918 virus that its genetic code could be sequenced. The virus was then reconstituted at the U.S. Centers for Disease Control and remains the subject of ongoing research in select high-security laboratories.

But the fragments of viral RNA used in the painstaking task were taken from tissues of people who died in the fall of 1918. To date no one has found samples of the virus or viruses responsible for illness in the spring of 1918.

There is some high-profile support for the argument Taubenberger and Morens make.

Dr. Walter Dowdle, a retired former head of the influenza program at the U.S. Centers for Disease Control, suggested so much has changed in the world since previous pandemics - the last was in 1968 - and so much is unknown about why flu behaves the way it does that it is impossible to predict the course of this pandemic based on previous ones.

"I think what this article recognizes is that this is very, very complex," Dowdle said from Atlanta. "And in fact our understanding of the factors is so incomplete and so insufficient that I think we have to be very careful about coming up with any simple theories to explain any flu behaviour."

One of Dowdle's former CDC colleagues, Dr. D.A. Henderson, thinks there is a model for the current pandemic, but it's not 1918.

Henderson, an infectious diseases expert at the Center for Biosecurity at the University of Pittsburgh Medical Center, recently published a review article suggesting if authorities are trying to figure out how to gauge public health responses to the swine flu pandemic they should look to the lessons of the 1957 Asian flu.

"I think that what we've seen in '57 and what we see now are very similar," he said in an interview.

"And I think they (Taubenberger and Morens) feel the same way I do that we have really no evidence that this (virus) is likely to become more virulent ... or more infectious."

But another researcher who has spent a lot of time mining records from 1918 believes there is good evidence the 1918 virus was responsible for the outbreaks of the herald wave.

Dr. Lone Simonsen, an influenza epidemiologist at George Washington University in Washington, D.C., has studied medical data for a number of centres that reported outbreaks in the spring of 1918 - New York and Denmark among them.

"There's always this discussion about 'If you don't have a virus, can you say anything about something?"' she said.

Simonsen argued the answer is yes, if the pattern of disease bears the signature of flu pandemic - things like a shift in the age group in which severe disease is seen. That was observed in the spring of 1918 and in the spring of 2009 as well, she noted.

"Absolutely there was a first wave that was milder. There's no doubt about it," she said.

Simonsen said accepting that there was a herald wave of illness doesn't mean that the change in severity in the fall has to have been the result of viral mutations. There could be other explanations, she said, including concurrent spread of bacterial illness that combined to make the flu cases more dangerous.

As to the path of the current pandemic, Simonsen suggested the best approach is a prudent one.